Restaurateur has a policy in Peru

Dec. 10, 2013

Gus Hermoza owns Mr. Sparky, a Peruvian restaurant in New Rochelle. Hermoza, photographed Nov. 25, 2013, gave up his health insurance several years ago when premiums rose to $900 a month. As a result, he flies to Peru every three to four months in order to get treatment for diabetes. He says that medical care for his diabetes in Peru costs him about $1,000 a month. He hopes to be able to obtain medical insurance through the Affordable Care Act that he will be able to afford so that he can get all his medical treatment in this country. ( Seth Harrison / The Journal News ) / Seth Harrison/The Journal News

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The Journal News is telling the stories of readers exploring health insurance options under New York’s new health exchanges. Read all the stories at lohud.com/affordablecare. For more information on the exchanges, visit www.nystateofhealth.ny.gov, or call 855-355-5777. Enrollment runs through March 31.

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Every few months, Gus Hermoza flies to Peru to see his doctor.

Hermoza, a New Rochelle restaurant owner, has lived in the United States for 30 years and is a citizen of both the U.S. and Peru. But it’s cheaper for him to spend $800 on a plane ticket five times a year — and to invest in a health insurance policy in Peru — than to pay for his medical expenses in the U.S.

“It’s really unfair that some people who don’t work get full coverage,” he says. “I’m a citizen, I pay taxes, I work hard, and I give jobs to other people in the United States, and I don’t get that opportunity. I deserve to have insurance.”

Status: Hermoza, 46, is separated, and has a 22-year-old son who has coverage through his employer. Until 2008, Hermoza had health insurance through HSBC, where he worked for 14 years, most recently as a loan officer. For two years afterward, he paid for his own health insurance, but the $900 monthly premiums proved too costly. Although he is certified as a mortgage broker, Hermoza’s primary income comes from Mr. Sparky, his Peruvian restaurant in New Rochelle’s west end. Since 2010, he’s had no health insurance in the United States. The policy he holds in Peru costs $1,000 a year, and covers the bulk of his medical and prescription expenses.

Health: Hermoza has Type 2 diabetes, and takes three medications. He buys all his medicine in Peru.

Considerations: Hermoza wants a policy with no deductible, and would like to pay no more than $500 a month in premiums. He wants to make sure his plan will include endocrinologists who specialize in treating diabetes.

Cost: Using the New York State of Health online calculator, and estimating Hermoza’s annual salary at $43,000, he is eligible for a subsidy that will reduce the cost of his monthly premiums. A platinum plan from Health Republic, at about $490 a month, is his least costly zero-deductible option; participating doctors include numerous diabetes specialists.

Bottom line: Hermoza plans to wait until January, after he’s completed his 2013 tax returns, to apply online for health insurance. But he is looking forward to ending his doctor-related trips to Peru. “If I had a good plan here, I would definitely stay,” he says.